| NPI | 1972188407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESTINEE MAYESE MONTELL FRAZIER Owner/ Operator 980-355-3104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BN1400X Durable Medical Equipment & Medical Supplies Nursing Facility Supplies |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2021-03-16 |